Little's novels tend to have simplistic titles (many use the construction "The [noun]", like The Mailman and The House) and fall squarely into the horror genre. He dislikes his work being categorised as "suspense" or "supernatural thriller", preferring the more straightforward genre label. His work has been championed by Stephen King, leading to increased recognition.[3]

In 2007 Little's short story "The Washingtonians" was adapted for the TV show Masters of Horror, becoming the twelfth episode of its second season. Directed by Peter Medak, it significantly lightened the tone of the author's original work, aiming for camp over the short story's dark humour. It was negatively received by critics.